Prevention and Treatment Strategies for Mesh Infection in Abdominal Wall Reconstruction.

BACKGROUND: Mesh infection remains the most feared complication after abdominal wall reconstruction, requiring prolonged hospitalizations and often, mesh removal. Understanding of current prevention and treatment strategies is necessary in the management of a common surgical problem.

METHODS: A comprehensive review of the current surgical literature was performed to determine risk factors of mesh infection after abdominal wall reconstruction and best practices in their prevention and surgical management.

RESULTS: Patient-related risk factors for mesh infections include smoking, obesity, diabetes mellitus, and COPD. Surgical risk factors such as prolonged operative time and prior enterotomy should also be considered. Prevention strategies emphasize reduction of modifiable risk factors, including obesity and diabetes among other comorbidities. Biologic or biosynthetic mesh is recommended in contaminated fields and use of delayed wound closure or vacuum-assisted closure therapy should be considered in high-risk patients. Conservative treatment with antibiotics, percutaneous or surgical drainage, and negative-pressure vacuum-based therapies have demonstrated limited success in mesh salvage. Mesh infection often requires mesh explantation followed by abdominal wall reconstruction. Staged repairs can be performed; however, definitive hernia repair with biologic mesh has shown promising results.

CONCLUSIONS: Management of mesh infections is a complex, yet commonly faced problem. Strategies used in the prevention and surgical treatment of infected mesh should continue to be supported by high-quality evidence from prospective studies.